CME Seminar Registration
* Last name: * required field
* First name:
* Address:
* City:
* State:
* Zip code:
* Phone:
* Email:
Specialty:
Class year:

Non-CME Attendees
Guest Name(s):
How many guest meal tickets @ $60?
Will you attend the Alumni Banquet? Yes No
Will your guest(s) attend the Alumni Banquet? Yes No
Do you or your guest have special dietary needs?

Wednesday, Sept. 9, Golf Tournament
How many players ($100/each)?
How many student sponsorships ($75/each)?

Thursday, Sept. 10, Class Reunion Dinners
Complimentary for you and a guest  
Will you attend the Reunion Dinner? Yes No
Will your guest attend the Reunion Dinner? Yes No
Guest Name

Please select your class year

1949
1954
1959
1964		 1969
1974
1979
1984 		1989
1994
1999
2004

Friday, Sept. 11, Basic Life Support Certification
1:00 p.m. - 4:00 p.m. Advanced registration required.  Seating is limited.
How many seats would you like to reserve ($15/each)?

Registration Fees
Registration includes all meals: Thursday breakfast and lunch; Friday breakfast, lunch and alumni banquet; Saturday breakfast and lunch; Sunday breakfast; refreshments; course materials; and CME Certificate of Attendance.
Physician Non-Alumni Association Member Save $100 if postmarked before Aug. 26!
$700.00
Physician Alumni Association Member Active Alumni Association members receive a $70 discount! (Renew your membership below.) Save $100 if postmarked before Aug. 26!
$630.00
KCUMB Community Clinical Faculty Save $100 if postmarked before Aug. 26!
$525.00
Nurse or Physician-Assistant Save $50 if postmarked before Aug. 26!
$475.00
KCUMB-COM Educational Consortium Residents, Interns and Students CME Seminar program only
$0.00
Non-KCUMB Residents CME Seminar program only
$150.00
I will not be attending the CME seminar  
$0.00

2009 Alumni Association Dues
Yes, I want to pay my 2009 Alumni Association Dues ($50)

For more information, please contact the Alumni Department
at 816-283- 2455
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